STAR Kids Handbook

25-1, Revises Sections Throughout the Handbook

Revision Notice 25-1; Effective March 1, 2025

SectionTitleChange
1320Service Coordination and Programs Serving Member with Intellectual or Developmental DisabilitiesAmends language for clarification purposes. Removes example of PDN.
2030Managed Care Organization CoordinationAmends language for clarification purposes.
2112STAR Kids Member Residing in an NFAmends language for clarification purposes. Updates instructions for MCOs about maintaining an amended ISP.
2210Medical Necessity ExpirationUpdates instructions for MCOs to submit member SK-SAI’s to the TMHP Long Term Care Online Portal.
3110Assessment of Medical Necessity for Community FirstUpdates to change Medicaid Management Information System to Long Term Care Online Portal.
3120Assessment of Medical Necessity for the Medically Dependent Children ProgramUpdates to change Medicaid Management Information System to Long Term Care Online Portal.
3210Reassessment of Medical Necessity or Level of CareAmends language for clarification purposes.
3320Service Planning for Medically Dependent Children ServicesAmends language for clarification purposes. Removes language that MCOs receive a response file from TMHP.
3322Medically Dependent Children Program Individual Service Plan and Budget RevisionAmends language for clarification purposes. Updates instructions for MCOs about maintaining an amended ISP.
3329Reassessment Notification RequirementsUpdates the number of days required for PSU staff requirements if a member files a state fair hearing or external medical review.
4111Determining Institutional Level of CareAmends language for clarification purposes. Removes reference that TMHP makes MN determinations on behalf of HHSC.
4131Assessment of Nursing Facility of CareAmends language for clarification purposes. Removes reference that TMHP evaluates member eligibility for NF services. Replaces references to TMHP with HHSC.
4132Reassessment for a Nursing Facility Level of CareAmends language for clarification purposes. Updates language to include Medicaid Management Information System.
4300Private Duty NursingCorrects links to TMPPM’s Home Health Nursing and Private Duty Nursing Handbook, and TMPPM’s Children’s Services Handbook.
6200Denial/Termination of Medically Dependent Children ProgramAmends language for clarification purposes in Provides additional language for clarification of when HHSC terminates MDCP enrollment.
6210Denial/Termination Due to DeathAmends language for clarification purposes. Updates language to clarify when HHSC will terminate MDCP enrollment.
6220Denial/Termination Due to Residence in a Nursing FacilityAmends language for clarification purposes.
6240Denial/Termination as a Result of Exceeding the Cost LimitChanges title to Denial or Termination as a Result of Exceeding the Cost Limit Amends language for clarification purposes. Updates language to include Medicaid Management Information System.
6250Denial/Termination of Medical NecessityChanges title to Denial or Termination of Medical Necessity Amends language for clarification purposes. Replaces references to TMHP with HHSC.
7300State Fair Hearing Requests- Appealing MCO ActionsRemoves a reference to applicants and members requesting a state fair hearing for non-eligibility reasons.
7310Program Support Unit CoordinationAmends language for clarification purposes. Replaces references to TMHP with HHSC. Updates timeline where staff must enter SFH requests for MDCP eligibility in TIERS.
7312Evidence PacketAmends language for clarification purposes. Replaces reference to TMHP with HHSC Office of Medical Director.
7321Presentation of the Evidence PacketUpdates references to TMHP and HHSC, along with the MCO.
7322Hearing DecisionUpdates references to TMHP and HHSC, along with the MCO.
7410Action Taken on the Hearing DecisionDeletes section and changed title to Reserved for Future Use.
7610Sustained State Fair Hearing DecisionsUpdate language. Clarifies that HHSC Fair and Fraud Hearings staff mails out written decisions to the applicant, member or their legally authorized representative.
7612Reversed Appeal DecisionsAmends language for clarification purposes. Updates TxMedCentral reference to MCOHub.
7700Roles and Responsibilities of Texas Health and Human Services Commission Hearing OfficersDeletes section 7700 and replaced with Section 7800, Community First Choice State Fair Hearing. Amends language for clarification purposes.
7800Community First Choice State Fair HearingMoves to Section 7700 and deletes Section 7800.
Appendix IMCO Business Rules for SK-SAI and SK-ISPUpdates Section 2.5. Advises MCOs to contact HHSC with more needed information for MDCP MN determinations.
Appendix XISTAR Kids Plan CodesUpdates Amerigroup to Wellpoint and Children’s Medical Center to Aetna for the Dallas Service Area.  

23-4, Sections 1220, 2132, 3200, 3511, 5311, 7200, 7612, Form 2603 Instructions Revised

Revision Notice 23-4; Effective Dec. 1, 2023

The following change(s) were made:

SectionTitleChange
1220Long Term Services and SupportsAmends language for clarification purposes. Updates the definition of attendant care services.
2132MCO Coordination Procedures for an MDCP Applicant Approved for a Limited NF StayAmends language for clarification purposes. Updates instructions for MCOs around limited nursing facility (NF) stay. Removes the word “service coordinator” from mentions of “MCO service coordinator”.
3200Member ReassessmentRemoves an incorrect reference to Community First Choice (CFC). Removes the word “service coordinator” from mentions of “MCO service coordinator”.
3511STAR+PLUS Transition ActivitiesUpdates link to STAR+PLUS Handbook.
5311Developing the Individual Service Plan in the CDS OptionUpdates instructions for completing denials, reductions in services and suspensions. Updates instructions in the Consumer Directed Services (CDS) option for a registered nurse (RN). Removes the word “service coordinator” from mentions of “MCO service coordinator”.
7200External Medical ReviewAmends language around the external medical review (EMR) process.
7612Reversed Appeal DecisionsUpdates language around PSU procedures for reversed appeal decisions.
Form 2603 InstructionsForm 2603, STAR Kids Individual Service Plan (ISP) NarrativeRevises instructions for when to prepare or update Form 2603. Provides clarification on documenting changes to services on the individual service plan (ISP) and provides clarification for when changes can be made.

23-3, Changes TexMedCentral Reference to MCOHub Throughout Handbook

Revision Notice 23-3; Effective July 21, 2023

The following change(s) were made:

SectionTitleChange
1311Member Refusal to Participate in Service CoordinationChanges reference from TxMedCentral to MCOHub.
1630Communication with the Managed Care OrganizationChanges reference from TxMedCentral to MCOHub.
1810Program Support Unit Notification RequirementsChanges reference from TxMedCentral to MCOHub.
2030Managed Care Organization CoordinationChanges reference from TxMedCentral to MCOHub.
2111Non-STAR Kids Individual Residing in an NFChanges reference from TxMedCentral to MCOHub.
2112STAR Kids Member Residing in an NFChanges reference from TxMedCentral to MCOHub.
2113MDCP MFP Applications Pending Due to Delay in NF DischargeChanges reference from TxMedCentral to MCOHub.
2131Individual Who is Approved for a Limited NF StayChanges reference from TxMedCentral to MCOHub.
2132MCO Coordination Procedures for an MDCP Applicant Approved for a Limited NF StayChanges reference from TxMedCentral to MCOHub.
2133Delays in Limited NF Stay for an Applicant Not Enrolled in STAR KidsChanges reference from TxMedCentral to MCOHub.
2210Medical Necessity ExpirationChanges reference from TxMedCentral to MCOHub.
2220MDCP Start of Care Date for Interest List ReleasesChanges reference from TxMedCentral to MCOHub.
2230Member ReassessmentChanges reference from TxMedCentral to MCOHub.
3200Reassessment of Medical Necessity or Level of CareChanges reference from TxMedCentral to MCOHub.
3210Reassessment of Medical Necessity or Level of CareChanges reference from TxMedCentral to MCOHub.
3329Reassessment Notification RequirementsChanges reference from TxMedCentral to MCOHub.
3410Transfer from One Managed Care Organization to AnotherChanges all references to TxMedCentral to MCOHub
3420Member Transfer from Waiver Program to Medically Dependent Children ProgramChanges all references to TxMedCentral to MCOHub
6200Denial/Termination of Medically Dependent Children ProgramChanges reference from TxMedCentral to MCOHub.
6210Denial/Termination Due to DeathChanges reference from TxMedCentral to MCOHub.
6220Denial/Termination Due to Residence in a Nursing FacilityChanges reference from TxMedCentral to MCOHub.
6270Denial/Termination Due to Failure to Meet Other Program RequirementsChanges reference from TxMedCentral to MCOHub.
6280Denial/Termination for Other ReasonsChanges reference from TxMedCentral to MCOHub.
7510Continuation of Medically Dependent Children Program Waiver Services During a State Fair HearingChanges reference from TxMedCentral to MCOHub.
7520Discontinuation of Medically Dependent Children Program Waiver Services During a State Fair HearingChanges reference from TxMedCentral to MCOHub.
7800Community First Choice State Fair HearingChanges reference from TxMedCentral to MCOHub.
Appendix IXStar Kids TxMedCentral Naming ConventionsChanges reference from TxMedCentral to MCOHub.
GlossaryGlossaryChanges reference from TxMedCentral to MCOHub. Relocates MCOHub to the M section of the glossary for alphabetical order.

23-2, Updates Appendix III

Revision Notice 23-2; Effective July 7, 2023

The following change(s) were made:

SectionTitleChange
Appendix IIILTSS Billing Matrix and CrosswalkUpdates billing matrix. Adds clarifying language and corrects a revenue code.